Quantifying the breadth of antibiotic exposure in sepsis and suspected infection using spectrum scores

A retrospective cohort study. Studies to quantify the breadth of antibiotic exposure across populations remain limited. Therefore, we applied a validated method to describe the breadth of antimicrobial coverage in a multicenter cohort of patients with suspected infection and sepsis. We conducted a retrospective cohort study across 21 hospitals within an integrated healthcare delivery system of patients admitted to the hospital through the ED with suspected infection or sepsis and receiving antibiotics during hospitalization from January 1, 2012, to December 31, 2017. We quantified the breadth of antimicrobial coverage using the Spectrum Score, a numerical score from 0 to 64, in patients with suspected infection and sepsis using electronic health record data. Of 364,506 hospital admissions through the emergency department, we identified 159,004 (43.6%) with suspected infection and 205,502 (56.4%) with sepsis. Inpatient mortality was higher among those with sepsis compared to those with suspected infection (8.4% vs 1.2%; P < .001). Patients with sepsis had higher median global Spectrum Scores (43.8 [interquartile range IQR 32.0–49.5] vs 43.5 [IQR 26.8–47.2]; P < .001) and additive Spectrum Scores (114.0 [IQR 57.0–204.5] vs 87.5 [IQR 45.0–144.8]; P < .001) compared to those with suspected infection. Increased Spectrum Scores were associated with inpatient mortality, even after covariate adjustments (adjusted odds ratio per 10-point increase in Spectrum Score 1.31; 95%CI 1.29–1.33). Spectrum Scores quantify the variability in antibiotic breadth among individual patients, between suspected infection and sepsis populations, over the course of hospitalization, and across infection sources. They may play a key role in quantifying the variation in antibiotic prescribing in patients with suspected infection and sepsis.     

Urinary Antibiotics and Dietary Determinants in Adults in Xinjiang,West China

The Xinjiang autonomous region, located in west China, has a unique ethnic structure and a well-developed livestock industry. People in this region have a high risk of exposure to antibiotics, but the exposure level to antibiotics in relation to dietary determinants is unknown. In this study, 18 antibiotics, including four human antibiotics (HAs), four veterinary antibiotics (VAs), and 10 preferred veterinary antibiotics (PVAs) were detected in the urine of approximately half of the 873 adults in Xinjiang, including Han Chinese (24.6%), Hui (25.1%), Uighur (24.6%), and Kazakh (25.7%). Logistic regression was used to analyze the association between antibiotic exposure levels and adult diet and water intake. The detection percentage of antibiotics in the urine of adults in Xinjiang ranged from 0.1% to 30.1%, with a total detection percentage of all antibiotics of 49.8%. HAs, VAs and PVAs were detected in 12.3%, 10.3%, and 40.5%, respectively. Fluoroquinolones were the antibiotics with the highest detection percentage (30.1%) and tetracyclines were the antibiotics with the highest detected concentration (17 ng/mL). Adults who regularly ate pork, consumed fruit daily, and did not prefer a plant-based diet were associated with thiamphenicol, norfloxacin, and fluoroquinolones, respectively. These results indicated that adults in the Xinjiang autonomous region were extensively exposed to multiple antibiotics, and some types of food were potential sources of exposure. Special attention should be paid to the health effects of antibiotic exposure in humans in the future.     

2019—2021年天津市宝坻区人民医院住院患者多重耐药菌检出及耐药分析

目的 探讨2019—2021年天津市宝坻区人民医院住院患者多重耐药菌（MDRO）检出及耐药分析,为临床抗菌药物的合理应用提供依据。方法 收集2019年1月—2021年12月天津市宝坻区人民医院住院患者送检标本分离的MDRO,排除同一患者同一部位分离的重复菌株。采用法国生物梅里埃公司VITEK-2 Compact型全自动微生物鉴定与药敏分析仪进行病原菌鉴定和药敏试验。对临床使用的3类或3类以上抗菌药物同时呈现耐药的细菌定义为MDRO并进行耐药分析。结果检出多重耐药菌1 083株,其中产超广谱β-内酰胺酶（ESBLs）大肠埃希菌645株（59.56%）、产ESBLs肺炎克雷伯菌144株（13.3%）、多重耐药鲍曼不动杆菌（MDRAB）140株（12.93%）、耐甲氧西林金黄色葡萄球菌（MRSA）79株（7.29%）、多重耐药铜绿假单胞菌（MDRPA）54株（4.99%）、耐碳青霉烯的肠杆菌（CRE）21株（1.94%）。2019—2021年,MDRAB、MDRPA和CRE的检出率比较差异有统计学意义（P<0.05）;组间比较,MDRAB的检出率2021年高于2020年（P<0....     

抗生素在新生儿肺炎治疗中的应用及时间效应分析

目的 探究在新生儿肺炎治疗中应用抗生素的效果及时间效应。方法 随机抽取2018年3月—2019年12月医院252例新生儿肺炎患儿为观察对象,回顾性分析其临床资料,结合不同抗生素使用方法将其分为甲组(87例,施行注射用哌拉西林钠他唑巴坦钠治疗)、乙组(82例,施行注射用头孢哌酮钠舒巴坦钠)、丙组(45例,施行注射用哌拉西林钠他唑巴坦钠+阿奇霉素治疗)、丁组(38例,施行注射用头孢哌酮钠舒巴坦钠+阿奇霉素治疗)。对比四组患儿临床治愈率、时间效应情况及不良反应发生率。结果(1)四组患儿临床治愈率对比差异无统计学意义(P> 0.05);(2)甲、乙、丙、丁四组平均治愈时间分别为(5.56±0.25)d、(5.35±0.31)d、(5.15±0.23)d、(5.09±0.24)d,对比可知结果差异无统计学意义(P> 0.05);(3)丁组不良反应发生率(11.11%)较甲组(2.30%)、乙组(1.22%)更高,χ²=6.087、7.791,差异有统计学意义(P <0.05),其余各组对比差异无统计学意义(P> 0.05)。结论 在新生儿肺炎治疗中,...     

2013-2014年河北北方学院附属第一医院住院抗菌药物处方的不合理用药分析

目的调查2013—2014年河北北方学院附属第一医院住院抗菌药物处方不合理用药的情况,为促进临床合理应用抗菌药物提供依据。方法抽取2013年1月—2014年12月河北北方学院附属第一医院住院抗菌药物处方20 000张,对不合理用药情况进行回顾性分析。结果抗菌药物处方存在不合理用药问题的共1 623张,占8.12%;其中存在的问题主要为溶媒种类的选择及溶媒量不当、给药剂量及给药频次不合理、疗程过长或偏短、联合用药指征不明确等;联合用抗菌药物品种数越多,不合理用药的发生率越高;头孢类和青霉素类使用率均较高,不合理用药处方率分别为7.50%、6.19%;而使用率均较低的碳青霉烯类、头霉素类以及抗真菌药处方中不合理用药处方率较高,分别为19.16%、18.36、19.17%。结论河北北方学院附属第一医院住院患者抗菌药物使用基本合理,但仍存在一些问题,需进一步加强临床医师合理应用抗菌药物的相关培训,并加大处方点评力度。     

紫红路南菌素A和B产生菌的分类、发酵和生物学特性研究

从我国云南省路南县采集的土壤样品中分离到一株链霉菌,编号为SIIA76-1289。它的孢子丝卷曲或螺旋,孢子球形或椭园形,表面带刺。经形态、培养特征和生理生化特性的研究和比较,认为SIIA76-1289菌株与紫色链霉菌(Streptomyces violaceus)基本相似。命名为紫色链霉菌路南变种(Streptomyces violaceus var.lunanensis var.nov.)。所产生两个蒽环类抗生素A和B,能够抗革蓝氏阳性细菌。在体外对白血病P388细胞DNA的合成有很强抑制作用。     

TEM-116型ESBL天然酶与重组酶的动力学特性研究

目的 研究TEM-116型ESBL天然酶与重组酶的动力学特性，并比较它们的差异。方法 采用紫外分光光度法检测酶促抗生素水解反应，以Lee-Wilson改良双倒数方程数据处理法进行数据处理，测定天然酶与重组酶的Km、Vmax及kcat，观察温度和pH对酶促反应的影响。结果 以Lee-Wilson改良双倒数方程数据处理法进行数据处理方便而准确地测定了天然酶与重组酶的Km与Vmax并计算出kcat,温度和pH对天然酶与重组酶酶促反应效应相似。天然酶与重组酶最优先的底物均为头孢哌酮，其次是头孢氨苄；对氨苄西林、阿莫西林、青霉素和哌拉西林有最高的催化效率。结论 天然酶与重组酶的动力学参数无显著差异。     

抗肿瘤抗生素抗体靶向药物研究新进展

新近研究发现,卡里奇霉素、力达霉素等抗肿瘤抗生素对某些靶点显示高度活性,对癌细胞具有极强的杀伤作用,可以作为高效＂弹头＂药物,用于构建抗体靶向药物,包括化学免疫偶联物和融合蛋白。抗体靶向药物由于体内分布的特异性及作用的专一性,具有强大的抗肿瘤优势。本文主要对几类抗肿瘤抗生素抗体靶向药物的构建及作用特点等进行综述,并初步展望其未来研究方向。     

对梭状芽孢厌氧菌有作用的新抗生素T0007A的研究——Ⅱ.抗生素T0007A的分离和鉴别

从一株吸水链霉菌的培养液中分离得到对难辨梭状芽孢杆菌有作用的抗生素T0007A。基于其理化及生物学性质、光谱特征和氨基酸分析结果,确认抗生素T0007A为由脯氨酸∶亮氨酸∶异亮氨酸(8∶7∶1)组成的新肽类抗生素。